Being a patient pays in training program for students at MCO

Medical student Jacob Bieszczad examines 'patient' Louise Dishong during a session at Medical College of Ohio. The program aims to help train medical students in a variety of situations.

Some days, Ray Mack has neck pain and a headache. Other days, he's tired and his legs hurt. And then there are the panic attacks.

But in reality, the 68-year-old couldn't be happier or healthier.

He's one of 330 area residents ages 13 to 85 hired by the Medical College of Ohio to pretend they have a variety of ailments. MCO students, like those at many other medical schools nationwide, then practice their diagnostic skills on them.

From posing as someone with heart pain to letting students practice doing breast exams or physicals on them, however, standardized patients provide an invaluable teaching tool at MCO and other medical schools nationwide, helping to turn out better doctors, nurses, and other health professionals.

"The majority of medical schools use standardized patients. They're a very powerful tool and excellent for teaching," said M. Brownell Anderson, a vice president of medical education for the Association of American Medical Colleges. "They're useful for exposing students to conditions they might not encounter in the course of a clinical experience."

Mr. Mack is a retired hospice nurse and former furniture store owner who now lives in Temperance, Mich. He likes making a little extra money - standardized patients earn $10 to $25 an hour for a few hours a month of work - but mostly he enjoys helping train tomorrow's doctors and nurses.

"I thought it would be interesting to help them learn," said Mr. Mack, who's been a standardized patient at MCO for about 15 years. "I really enjoy helping the students."

Patients like Mr. Mack don't just help students learn how to tap a knee to check reflexes, either. Ms. Anderson said medical schools today are trying to improve their students' bedside manners, including how to break bad news to patients.

MCO announced receipt of a $1.9 million donation last month from the estate of a former Toledo woman whose bad experience with a New York physician convinced her that medical schools needed to do a better job of teaching communication skills. Ruth Hillebrand was called late one night by her physician and told she had a rare and incurable form of cancer. The doctor then hung up.

At a recent visit to MCO's Ruth Hillebrand Clinical Skills Center, Mr. Mack and his "wife" demonstrated how he and other patients try to prevent MCO students from making mistakes like that.

Their assignment that day was for Mr. Mack and Louise Dishong, 72, to act as an elderly couple who are told that the husband - Mr. Mack - has been diagnosed with Alzheimer's Disease. Second-year medical student Jacob Bieszczad, 24, was learning how to present this difficult news to patients.

He entered a room at the clinical skills center which looks like the average exam room, complete with an examination table, sink, and generic piece of artwork on the wall.

"So, you guys know we've been running some tests," Mr. Bieszczad explained as he pulled up a chair close to Mr. Mack and Ms. Dishong. "Based on our limited knowledge, we think you may have Alzheimer's."

Ms. Dishong put a hand to her mouth and exclaimed, "Ohhhhh! Are you sure?"

She asked if they could get a second opinion. Mr. Bieszczad assured that not only could she get a second opinion, but he encouraged her to do so. He then leaned in closer and explained that MCO has support groups and other help to offer.

Mr. Mack, looking scared, wondered: "Couldn't it be my heart?"

"I just though he was getting older," Ms. Dishong continued as she grabbed Mr. Mack's hand. "Oh, God! My grandfather had Alzheimer's and it was horrible."

The performances are startling in how real they seem. As the conversation continued, tears began to well in Ms. Dishong's eyes and she became emotional.

"Are you going to be OK? Do you need a Kleenex?" Mr. Bieszczad asked as he tried to calm her. "Oh," Ms. Dishong wailed, "How are we going to tell the kids? Our kids live so far away, we live here all alone."

"If you want to bring your kids here when they come to town, I'll explain it to them," Mr. Bieszczad reassured.

For the third time in a matter of minutes, Mr. Mack again asked in a sad voice: "Couldn't it be my heart?"

At the end of the session, Mr. Mack and Ms. Dishong become themselves again and the feedback begins.

"I liked how you made eye contact," Mr. Mack told Mr. Bieszczad. "You're showing concern, which was good. But you should slow down a little bit."

After his evaluation is finished, Mr. Bieszczad explained to an observer why he likes practicing on standardized patients.

"This is such a valuable experience," the Toledo native said. "I was doing a breast exam and one lady told me, 'You're not pushing hard enough to find cancer.' "

His training experience is a far cry from what the center's medical director, Dr. Mary R. Smith., received years ago.

"When I was in medical school, nothing like this existed," she said. "That first encounter with a patient was frightening. My first patient was an older gentleman, and in my era, there were fewer women doctors. Well, he promptly threw me out of the exam room."

She always remembered that experience, and 15 years ago pushed MCO officials to start a training program using standardized patients. Many of her colleagues at the questioned it, she recalled, and warned her it would never catch on at MCO, because at the time, there was only a handful of such programs.

But MCO students and faculty quickly learned to appreciate the training, Dr. Smith said, and now "we have one of the oldest and biggest programs in the country."

MCO makes a concerted effort to use "real" people and train them how to act out a variety of ailments in the hopes of giving students a more accurate sense of patient interaction.

Like all the other participants in the MCO program, Ms. Dishong, who lives in Toledo and is retired from the property management business, has never been an actor before. Yet she enjoys the acting, even turning on the tears when needed.

"It's rewarding, especially if you've had a bad doctor," Ms. Dishong said. "You think, 'Well, I'll help make a difference.' "

But pity the real doctors who see Ms. Dishong or MCO's other standardized patients during real check-ups.

"In my mind I'm saying [things to myself like], 'Oh, she didn't use her stethoscope right,'" she laughed.

The use of standardized patients has become so valued that it's being incorporated into tests students must pass before getting their medical license, according to Judy Riggle, director of MCO's clinical skills center.

"It's much more high stakes now," Ms. Riggle said.

At MCO, the standardized patients play two main roles. Part of the time they're acting as patients for students and giving feedback. The other part of their stay at MCO the standardized patients sit behind view screens and watch as their counterparts are examined by students.

Each exam room has video cameras capturing the practice session. A student's performance is evaluated, and MCO professors also get reports on how their students are doing.

Back in a waiting area of MCO's clinical skills center, Mr. Mack was finished for the day and was chatting with Mr. Bieszczad. Other than a few minor mistakes, Mr. Mack said he was impressed with how well the young student had done, especially compared to how well he did the year before.

"You've improved considerably," he said, which brought a grin to Mr. Bieszczad's face.

Dr. Smith said she is happy when she hears reports like that.

"I just think MCO is superfortunate to have this," she said. "To have a center like this, it's really a resource for our whole area. And patients in the long run will get better care."

Contact Luke Shockman at: lshockman@theblade.com or 419-724-6084.